Evaluating the effectiveness and implementation of evidence-based early-life nutrition interventions in a community setting a hybrid type 1 non-randomized trial - the Nutrition Now project protocol.

Disappointingly few efficacious health interventions are successfully scaled up and implemented in real world settings. This represents an evidence-to-practice gap, with loss of opportunity to improve practice. Aiming to improve nutrition in the first 1000 days of life, we have combined four efficacious dietary interventions into a single adapted digital resource (Nutrition Now) for implementation in a Norwegian community setting. Nutrition Now targets pregnant women and parents of 0-2-year-olds with messages focusing on healthy dietary behaviours. Early childhood education and care (ECEC) staff are provided with pedagogical tools addressing healthy food exposure and child food acceptance. Objectives: a) evaluate the effectiveness of provision of the Nutrition Now resource on child diet and diet-related outcomes, with special attention to the influence of socio-economic position, b) gather information on the effectiveness of the implementation process to inform forthcoming scale-up and c) perform trial- and model-based economic evaluations. This is a hybrid type 1 implementation study, focusing on evaluation of effectiveness. A quasi-experimental design with pre- and post-tests, where one municipality gets access to the resource (n~800), while a matched non-equivalent control municipality (n~800) does not, will be used. Effectiveness will be assessed by examining e.g., diet outcomes, developmental outcomes, and feeding practices. The resource will be implemented in ECEC settings and made available to pregnant women and parents through the Norwegian system of maternal and child health (MCH) care. The implementation process includes iterative adjustments and implementation strategies from the implementation framework Expert Recommendations for Implementing Change (ERIC) informed by dialogues with stakeholders. Implementation outcomes (e.g., acceptability and adoption) will be assessed through questionnaires and interviews with parents, ECEC and MCH staff, with particular attention to ethnic diverse groups. Both within-trial and modelling-based economic evaluation will be performed. Nutrition Now will bridge the existing evidence-to-practice gap through rigorous scientific effectiveness evaluation of municipal scale up and inform subsequent county scale up. The study is the first to implement efficacious nutrition interventions in early life with potential for health improvement using technology to maximise the reach and impact of both parental and MCH dietary guidance and ECEC practice. Clinical Trial Registration: https://www.isrctn.com/, identified ISRCTN10694967.

Predicting Sustainable Employability in Swedish Healthcare: The Complexity of Social Job Resources.

Achieving sustainable employability (SE), i.e., when employees are able to continue working in a productive, satisfactory, and healthy manner, is a timely challenge for healthcare. Because healthcare is a female-dominated sector, our paper investigated the role of social job resources in promoting SE. To better illustrate the complexity of the organizational environment, we incorporated resources that operate at different levels (individual, group) and in different planes (horizontal, vertical): trust (individual-vertical), teamwork (group-horizontal), and transformational leadership (group-vertical). Based on the job demands-resources model, we predicted that these resources initiate the motivational process and thus promote SE. To test these predictions, we conducted a 3-wave study in 42 units of a healthcare organization in Sweden. The final study sample consisted of 269 professionals. The results of the multilevel analyses demonstrated that, at the individual level, vertical trust was positively related to all three facets of SE. Next, at the group level, teamwork had a positive link with employee health and productivity, while transformational leadership was negatively related to productivity. These findings underline the importance of acknowledging the levels and planes at which social job resources operate to more accurately capture the complexity of organizational phenomena and to design interventions that target the right level of the environment.

A Piece of the Boardroom Pie-An Interview Study Exploring What Drives Swedish Corporate Boards' Engagement in Occupational Health and Safety.

OBJECTIVES: To investigate why boards of directors engage in occupational health and safety (OHS) and what influences their level of engagement. METHODS: Thirty-four board members and chief executive officers at large companies from the manufacturing, construction, trade, and health/social care sectors were interviewed. An inductive thematic analysis was conducted. RESULTS: Five drivers organized along a continuum explain why boards engage: legal compliance, untoward events, external expectations/regulations, business drivers, and moral values. Certain factors influence the level of engagement: board's OHS competence, owner's agenda, and competing needs. CONCLUSIONS: Boards continuously prioritize among multiple foci. If a board's total engagement is likened to a pie, the size of the OHS slice will depend on the drivers, as well as on the influencing factors. We suggest that even boards with many drivers can down-prioritize OHS under certain conditions.

Does lean implementation interact with group functioning?

PURPOSE: As healthcare often is studied in relation to operational rather than socio-technical aspects of Lean such as teamwork, the purpose of this paper is to explore how a Swedish hospital Lean intervention was related to changes in teamwork over time. DESIGN/METHODOLOGY/APPROACH: Teamwork was measured with the Group Development Questionnaire (GDQ) employee survey during Lean implementation at three units, in 2010 (n = 133) and 2011 (n = 130). Qualitative data including interviews, observations and document analysis were used to characterize the Lean implementation and context. The expected teamwork change patterns were compared with GDQ data through linear regression analysis. FINDINGS: At Ward-I, Lean implementation was successful and teamwork improved. At Ward-II, Lean was partially implemented and teamwork improved slightly, while both Lean and teamwork deteriorated at the emergency department (ED). The regression analysis was significant at ED (p = 0.02) and the Ward-II (p = 0.04), but not at Ward-I (p = 0.11). RESEARCH LIMITATIONS/IMPLICATIONS: Expected changes in teamwork informed by theory and qualitative data may make it possible to detect the results of a complex change. PRACTICAL IMPLICATIONS: Overall, Lean may have some impact on teamwork, if properly implemented. However, this impact may be more prominent in relation to structural and productivity issues of teamwork than group members' relational issues. Practitioners should note that, with groups struggling with initial stages of group functioning, Lean may be very challenging. ORIGINALITY/VALUE: This study focussed specifically on implications of Lean for nurse teamwork in a hospital setting using both qualitative and quantitative data. Importantly, the group functioning at the time when Lean is initiated may affect the implementation of Lean.

Team behaviors in emergency care: a qualitative study using behavior analysis of what makes team work.

OBJECTIVE: Teamwork has been suggested as a promising approach to improving care processes in emergency departments (ED). However, for teamwork to yield expected results, implementation must involve behavior changes. The aim of this study is to use behavior analysis to qualitatively examine how teamwork plays out in practice and to understand eventual discrepancies between planned and actual behaviors. METHODS: The study was set in a Swedish university hospital ED during the initial phase of implementation of teamwork. The intervention focused on changing the environment and redesigning the work process to enable teamwork. Each team was responsible for entire care episodes, i.e. from patient arrival to discharge from the ED. Data was collected through 3 days of observations structured around an observation scheme. Behavior analysis was used to pinpoint key teamwork behaviors for consistent implementation of teamwork and to analyze the contingencies that decreased or increased the likelihood of these behaviors. RESULTS: We found a great discrepancy between the planned and the observed teamwork processes. 60% of the 44 team patients observed were handled solely by the appointed team members. Only 36% of the observed patient care processes started according to the description in the planned teamwork process, that is, with taking patient history together. Beside this behavior, meeting in a defined team room and communicating with team members were shown to be essential for the consistent implementation of teamwork. Factors that decreased the likelihood of these key behaviors included waiting for other team members or having trouble locating each other. Getting work done without delay and having an overview of the patient care process increased team behaviors. Moreover, explicit instructions on when team members should interact and communicate increased adherence to the planned process. CONCLUSIONS: This study illustrates how behavior analysis can be used to understand discrepancies between planned and observed behaviors. By examining the contextual conditions that may influence behaviors, improvements in implementation strategies can be suggested. Thereby, the adherence to a planned intervention can be improved, and/or revisions of the intervention be suggested.

Turning the tables: when the student teaches the professional -- a case description of an innovative teaching approach as told by the students.

BACKGROUND: Is it possible to increase the value, meaningfulness, and relevance of a course experience by integrating it with the healthcare context? Students and teachers from a course on organization, learning and leadership sought to explore this possibility through a collaborative effort with nurses from an affiliated teaching hospital. METHODS: Working as teachers, students created continuing nursing education (CNE) courses using the Adaptive Reflection process. The students and teachers then researched the experience in terms of: 1) content analysis of student self-reflections (discussion notes and logbooks) on the learning process, 2) a student self-assessed outcome achievement survey, and 3) perceived relevance of the CNE courses by the clinical nurse educators. RESULTS: Thirteen nursing students created three CNE courses together with sixteen nurses. Each course consisted of multiple 20-minute long web-based modules with automatic formative feedback. In the process, students exceeded course outcome-levels, journeyed from chaos to confidence and experienced new ways of viewing the group and their own capabilities. CONCLUSIONS: The innovative design of the course moved the focus from student-centered learning to learning by contributing to health care. Working in a real world context, the content of the students' efforts and the skills they developed not only met course requirements, but were also aligned with the needs of the wards. This contribution was valued by the students and the RNs which enhanced students' feelings of self-confidence. Further research lies in testing the model in other contexts.